Occurrence and genetic characterization of Enterocytozoon bieneusi in pet dogs in Yunnan Province, China.

Enterocytozoon bieneusi is the most common microsporidian species in humans and can affect over 200 animal species. Considering possible increasing risk of human E. bieneusi infection due to close contact with pet dogs and identification of zoonotic E. bieneusi genotypes, 589 fresh fecal specimens of pet dogs were collected from Yunnan Province, China to determine the occurrence of E. bieneusi, characterize dog-derived E. bieneusi isolates, and assess their zoonotic potential at the genotype level. Enterocytozoon bieneusi was identified and genotyped by PCR and sequencing of the internal transcribed spacer (ITS) region of the ribosomal RNA (rRNA) gene. Twenty-nine specimens (4.9%) were positive. A statistical difference was observed in occurrence rates of E. bieneusi in pet dogs among 11 sampling sites by Fisher's exact test. Fifteen genotypes were identified and all of them phylogenetically belonged to zoonotic group 1, including four known genotypes (EbpC, D, Peru 8, and Henan-III) and 11 novel genotypes. Genotype Henan-III was reported in dogs for the first time. The finding of known genotypes found previously in humans and novel genotypes falling into zoonotic group 1 indicates that dogs may play a role in the transmission of E. bieneusi to humans in the investigated areas.

Title: Occurrence et caractérisation génétique d'Enterocytozoon bieneusi chez les chiens de compagnie dans la province du Yunnan, Chine. Abstract: Enterocytozoon bieneusi est l'espèce de microsporidies la plus répandue chez l'homme et peut affecter plus de 200 espèces animales. Compte tenu du risque accru possible d'infection humaine à E. bieneusi en raison d'un contact étroit avec des chiens de compagnie et de l'identification de génotypes zoonotiques d'E. bieneusi, 589 échantillons fécaux frais de chiens de compagnie ont été collectés dans la province du Yunnan, en Chine, pour déterminer la présence d'E. bieneusi, caractériser les isolats obtenus de chiens, et évaluer leur potentiel zoonotique au niveau du génotype. Enterocytozoon bieneusi a été identifié et génotypé par PCR et séquençage de la région d'espacement transcrit interne (ITS) du gène de l'ARN ribosomal (ARNr). Vingt-neuf échantillons (4,9%) étaient positifs. Une différence statistique a été observée dans les taux de présence d'E. bieneusi chez les chiens de compagnie parmi 11 sites d'échantillonnage par le test exact de Fisher. Quinze génotypes ont été identifiés et tous appartenaient phylogénétiquement au groupe zoonotique 1, dont quatre génotypes connus (EbpC, D, Peru 8 et Henan-III) et 11 nouveaux génotypes. Le génotype Henan-III est signalé pour la première fois chez le chien. La découverte de génotypes connus précédemment trouvés chez l'homme et de nouveaux génotypes appartenant au groupe zoonotique 1 indique que les chiens peuvent jouer un rôle dans la transmission d'E. bieneusi aux humains dans les zones étudiées.

Agarose Hydrogel-Boosted One-Tube RPA-CRISPR/Cas12a Assay for Robust Point-of-Care Detection of Zoonotic Nematode Anisakis.

Rapid and accurate detection of the zoonotic nematode Anisakis is poised to control its epidemic. The clustered regularly interspaced short palindromic repeats (CRISPR)/Cas-associated assay shows great potential in the detection of pathogenic microorganisms. The one-tube method integrated the CRISPR system with the recombinase polymerase amplification (RPA) system to avoid the risk of aerosol pollution; however, it suffers from low sensitivity due to the incompatibility of the two systems and additional manual operations. Therefore, in the present study, the agarose hydrogel boosted one-tube RPA-CRISPR/Cas12a assay was constructed by adding the CRISPR system to the agarose hydrogel, which avoided the initially low amplification efficiency of RPA caused by the cleavage of Cas12a and achieved reaction continuity. The sensitivity was 10-fold higher than that of the one-tube RPA-CRISPR/Cas12a system. This method was used for Anisakis detection within 80 min from the sample to result, achieving point-of-care testing (POCT) through a smartphone and a portable device. This study provided a novel toolbox for POCT with significant application value in preventing Anisakis infection.

Epidemiological survey of cystic echinococcosis in southwest China: From the Qinghai-Tibet plateau to the area of Yunnan.

BACKGROUND: Echinococcosis is prevalent in 9 provinces in Western and Northern China. An epidemiological survey of echinococcosis in 2012 and 2016 showed cases of echinococcosis in Yunnan Province. AIM: To understand the spatial distribution and epidemiological characteristics of echinococcosis in Yunnan for the prevention and control of echinococcosis and to reduce the risk of infection in Yunnan Province. METHODS: Based on the China Information System for Disease Control and Prevention (CISDCP), echinococcosis cases reported from 36 hospitals and 34 Centers for Disease Control were investigated and epidemiologically analyzed from 2021 to 2022. The exclusion criteria included suspected cases, same case only counted once and cases not from Yunnan. A total of 705 cases were investigated, of which 397 cases were suitable for statistical analysis. In these 397 cases, epidemiological investigation was tracked in 187 cases. All data were inputted using double entry in the Excel database, with error correction by double-entry comparison. The data on echinococcosis cases in Yunnan Province were analyzed by ArcGIS 10.1 software to generate a density map of echinococcosis distribution. All statistical analyses were conducted using SPSS 17.0, including the chi-square test, linear regression test and logistic univariate and multivariate regression analyses. RESULTS: A total of 397 cases were found in 89 counties in Yunnan Province. The number of cases in the top three prefectures were Dali (38.1%), Diqing (10.1%), and Kunming (8.3%), and the top five counties were Jianchuan (9.1%), Shangri La (8.3%), Eryuan (7. 6%), Heqing (6.9%), and Dali Districts (5.0%). There were significant differences between the different areas. The case reporting rate by CISDCP (33.8%) was low; the first case was reported by CISDCP in 2002, and the highest number of cases was 50 (2017). Confirmed and clinical cases accounted for 62.5% and 37.5%, respectively. However, 90.9% of the cases of hydatid disease were reported by the hospital system, and only 9.1% of the cases of hydatid disease were found in the community through active screening. The difference between the two methods of case detection was statistically significant. Most of the cases of echinococcosis were found in farmers/herdsmen (75.1%) and students (9.1%). In addition, Han (43.6%) and Bai (26.2%) had a higher incidence of infection than other nationalities, and the liver (87.7%) and lung (6.8%) were the most common sites of cyst formation. Among the analyzed cases, 187 were epidemiologically analyzed and the clinical symptoms were not obvious in the early stage in 47.1% of cases. The results of logistic regression analysis showed that the age group, education level, presence of dogs in the family (either previously or currently), and handwashing (occasionally or not) were factors related to echinococcosis infection. 55.6% of cases were in endemic areas, and 44.4% of cases were in non-endemic areas. Among 83 cases in non-endemic areas, only 4 cases had been to endemic areas and had a history of living, working, travelling, or hunting in echinococcosis epidemic areas. CONCLUSION: Cases of echinococcosis were reported throughout the entire Yunnan province, with the majority distributed in Western Yunnan, suggesting that echinococcosis control should be strengthened in this area. We suggest that an epidemiological investigation should be carried out in the future, based on the clues from newly discovered cases in hospitals or from the CISDCP. The newly discovered cases in the hospital provided clues to comprehensively determine the location of cases and where epidemic spot investigation should be conducted.

Analysis of Epidemiological and Issues Encountered in Case Reports on Echinococcosis - China, 2022.

What is already known about this topic?: Echinococcosis is classified as a Class C infectious disease in China. It is endemic in 370 counties located in the agricultural and pastoral regions of western China. What is added by this report?: This report provides a comprehensive overview of the cases of echinococcosis reported in China in 2022. Following a thorough evaluation conducted by provincial CDCs, it was identified that 105 new cases were not reported through the National Notifiable Disease Reporting System. Furthermore, there were 1,051 cases that were reported among patients who had been previously diagnosed with echinococcosis. What are the implications for public health practice?: The reported cases of echinococcosis in non-endemic counties of provincial-level administrative divisions where the disease is endemic need to be given more attention, as there is a potential risk of it spreading within the non-endemic areas. Inadequate reporting practices by clinical medical institutions are hindering the subsequent investigations carried out by CDCs. It is important to implement enhanced health promotion efforts that focus on high-risk populations to address unhealthy lifestyles.

First survey of Enterocytozoon bieneusi and dominant genotype Peru6 among ethnic minority groups in southwestern China's Yunnan Province and assessment of risk factors.

BACKGROUND: Enterocytozoon bieneusi is the most common microsporidian species causing diarrhea and other intestinal disorders in humans and animals. Like other infectious diseases, microsporidiosis usually disproportionately affects poor populations. In China, some ethnic minority areas remain poor. Currently, no information of E. bieneusi infection is available in minority populations. The present aims were to understand occurrence and genetic characterizations of E. bieneusi in ethnic minority groups from a poverty-stricken ethnic township in Yunnan Province, and to assess risk factors for E. bieneusi infection. METHODOLOGY/PRINCIPAL FINDINGS: 289 fecal specimens were collected from Yao people (one specimen each) with and without diarrhea, in Yunnan Province. E. bieneusi was identified and genotyped by PCR and sequence analysis of the ITS region of the rRNA gene. An average prevalence of 8.30% (24/289) was observed and four genotypes were identified-genotype Peru6 (n = 21) and three novel genotypes (one each). Genotype Peru6 was detected in two family members in each of three families. In a phylogenetic analysis, all of four genotypes fell into group 1 with zoonotic potential. The people owning individual pit toilets had a statistically higher prevalence of E. bieneusi (16.67%, 12/72) than those using public pit toilets (6.06%, 12/198). CONCLUSIONS/SIGNIFICANCE: This is the first report on occurrence and genetic characteristics of E. bieneusi in ethnic minority groups in China. Genotype Peru6 was found in humans in China for the first time and showed dominance in Yao people. The same genotype was found in some family members and all the genotypes fell into group 1, suggesting the possibility of anthroponotic and zoonotic transmissions. The majority (83.33%, 20/24) of E. bieneusi positive individuals did not present diarrhea. In any case, it is important to recognize their existence and the importance that asymptomatic individuals to E. bieneusi may have from an epidemiological point of view, as transmitters of this pathogen. The analysis of risk factors provides scientific evidence for the development of effective strategies for prevention and control of E. bieneusi infection.

Malaria control along China-Myanmar Border during 2007-2013: an integrated impact evaluation.

BACKGROUND: Implementing effective interventions remain a lot of difficulties along all border regions. The emergence of artemisinin resistance of Plasmodium falciparum strains in the Greater Mekong Subregion is a matter of great concern. China has effectively controlled cross-border transmission of malaria and artemisinin resistance of P. falciparum along the China-Myanmar border. METHODS: A combined quantitative and qualitative study was used to collect data, and then an integrated impact evaluation was conducted to malaria control along the China-Myanmar border during 2007-2013. RESULTS: The parasite prevalence rate (PPR) in the five special regions of Myanmar was decreased from 13.6 % in March 2008 to 1.5 % in November 2013. Compared with the baseline (PPR in March 2008), the risk ratio was only 0.11 [95 % confidence interval (CI), 0.09-0. 14) in November 2013, which is equal to an 89 % reduction in the malaria burden. Annual parasite incidence (API) across 19 Chinese border counties was reduced from 19.6 per 10 000 person-years in 2006 to 0.9 per 10 000 person-years in 2013. Compared with the baseline (API in 2006), the API rate ratio was only 0.05(95 % CI, 0.04-0.05) in 2013, which equates to a reduction of the malaria burden by 95.0 %. Meanwhile, the health service system was strengthened and health inequity of marginalized populations reduced along the international border. CONCLUSION: The effective collaboration between China, Myanmar and the international non-governmental organization promptly carried out the core interventions through simplified processes. The integrated approaches dramatically decreased malaria burden of Chinese-Myanmar border.

Dynamic positron emission tomography restoration with low-rank representation incorporating edge preservation.

BACKGROUND: Dynamic positron emission tomography (PET) is a powerful tool that provides useful quantitative information on physiological and biochemical processes. However, the low signal-to-noise ratio (SNR) in short dynamic frames is a challenge. OBJECTIVE: To get high SNR in the dynamic PET and to achieve high-quality PET parametric image are the objective of this study. METHODS: Low-rank (LR) modeling and edge-preserving prior are incorporated in this study with a unified mathematical framework to improve the SNR of a dynamic PET image series. The proposed algorithm is designed to reduce noise in homogeneous areas while preserving the edges of regions of interest. RESULTS: The performance of the proposed method (LRH) is compared both visually and quantitatively by using the classic Gaussian filter and an LR expression filter on a digital brain phantom and in vivo rat study. Experimental results demonstrate that the proposed filter can achieve superior visual and quantitative performance without sacrificing spatial resolution. CONCLUSIONS: The proposed LRH is considerably effective and exhibits great potential in processing dynamic PET data with high noise levels.

[Survey on Malaria Epidemics in China-Myanmar Border Area].

The malaria epidemics in Laza city of Myanmar and Yingjiang county in Yunnan province of China in 2012 and 2013 was reviewed retrospectively, and a survey on malaria infection was conducted in residents in the border areas. A total of 179 malaria cases were reported in Yingjiang county from 2012 to 2013, with an average annual incidence of 2.9 per 10,000. Of the 179 cases, 77.7% were imported cases and 22.3% were local cases; 79.3% were infected with Plasmodium vivax, 20.1% with P. falciparum, and 0.6% unidentified. In Laza city of Myanmar, 2,069 malaria cases were reported, with an average annual incidence of 322.5 per 10,000. Of them, 73.4% cases were infected with P. vivax, 20.1% with P. falciparum and 6.5% unidentified. In addition, the microscopic results revealed that the malaria parasite rate in the residents in Yingjiang county was 0%, while that in Laza city was 1.5%.

[Comparison between the head-chest leads electrocardiogram and routine leads in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome].

OBJECTIVE: To observe whether there was difference between the head-chest leads electrocardiogram (HCECGs) and routine lead electrocardiogram (RLECGs) in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome. METHODS: HCECGs and RLECGs were recorded simultaneously in patients with Wolff-Parkinson-White syndrome, whose manifest accessory pathways had been confirmed by radiofrequency catheter ablation and intra-cardiac electrophysiology according to the same standard set beforehand. The diagnosis of pathways location was made by analysis of each HCECG and RLECG by two senior physicians in clinical electrophysiology. The diagnostic accuracy of the HCECGs and RLECGs was evaluated by the comparison with that of the intra-cardiac electrophysiology. The delta wave size was also compared between HCECGs and RLECGs. RESULTS: The diagnostic accuracy in the manifest accessory pathways was 86.2% (50/58) in RLECGs, and 84.4% (49/58) in HCECGs in the 58 patients with Wolff-Parkinson-White syndrome, showing no significant difference between them (P > 0.05), but each delta wave in HCECG was more evident than that in RLECG. CONCLUSION: HCECG and RLECG both have high diagnostic accuracy in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome.

[Relationship between reference point potential and potential distribution of normal electrocardial field on the thoracic surface of healthy individuals].

OBJECTIVE: To explore the effect of reference point on the potential distribution of normal cardioeleclric field of healthy individuals. METHODS: Two different reference points including central terminal and right forehead were applied to record electrocardiogram simultaneously from 15 testing points (V(1)-V(6), V(7)-V(9), V(3R)-V(8R)) of Wilson lead (RL) and the same testing points (HV(1)-HV(9), HV(3R)-HV(8R)) of head-chest (HC) lead around the torso of healthy individuals. Chi-square test was performed to observe statistical difference between the HCECGs and RLECGs according to different shapes of QRS and T waves. RESULTS: Among 120 healthy individuals, deformed ECGs appeared in V(1) and HV(3R)-HV(8R) leads, with 20% (24/120) inverted T wave in V(1) lead, 100% (120/120) in V(3R)-V(8R) leads, wide or deep Q wave 100% (120/120) in V(4R)-V(8R) leads. However, in the corresponding HC-lead system, T waves were all positive, and QRS waves were upright as the pattern of rs, RS or qRs. There was statistical difference in the form of ECG between V(1), V(3R)-V(8R) of Wilson lead and the corresponding HC-lead (P<0.05). The distribution of normal cardioeleclric field related to QRS-T wave was of all-round outward shape by HC-lead, and of roughly bipolar shape by Wilson lead for inverted QRS-T wave on the right thoracic surface. CONCLUSION: The normal distribution of electrocardial field is determined by the potential of the reference point. The forehead of HC-lead seems to be better than the central terminal as the reference point of the lead system.

[Evaluation of resultant cardiac vector based on voltage distribution of electrocardial field around ex vivo guinea pig heart].

OBJECTIVE: To evaluate the possibility of resultant cardiac vector of ex vivo guinea pig heart. METHODS: ECGs were recorded in 4 directions on every plane, and in each direction 4 points at different distances from the anterior, posterior, right and left of isolated guinea pig ventricles immersed in normal saline and distilled water. RESULTS: Main upward waves of ECGs were recorded at all points in 4 directions at 3 levels in the two media. The voltage distribution of normal electrocardial field of the QRS wave was of all-round outward shape, which did not match the resultant cardiac vectors between the left and right and between the anterior and posterior ventricular walls. CONCLUSION: There are some confusion and contradiction in the resultant cardiac vector based on the voltage distribution of electrocardial field around ex vivo guinea pig heart.

[Comparison of head-chest lead electrocardiogram and routine lead electrocardiogram in diagnosis of acute posterior wall myocardial infarction].

OBJECTIVE: To compare the value of head-chest lead electrocardiogram (HCECG) and routine lead electrocardiogram (RLECG) in diagnosis of acute positive posterior myocardial infarction. METHODS: HCECGs and RLECGs were recorded simultaneously in 68 normal individuals and 32 patients with acute posterior wall myocardial infarction confirmed by coronary angiography and echocardiography. Each HCECG and RLECG was analyzed by two senior physicians specialized in clinical electrophysiology who were blinded to the results. The HCECG- and RLECG-based diagnostic results were compared with the results of coronary angiography, and the coincidence rates and false positive rates of diagnosis based on HCECGs and RLECGs were calculated. RESULTS: The coincidence rate was 93.8% (30/32) for RLECGs and 100% (32/32) for HCECGs in the diagnosis of acute posterior wall myocardial infarction, showing no significant difference between them (P>0.05). RLECGs-based diagnosis, however, resulted in a significantly higher false positive rate than HCECGs [13.2% (9/68) vs 0% (0/68), P<0.05]. CONCLUSION: Head-chest lead system is superior to routine lead system for its low false positive rates in the diagnosis of acute posterior wall myocardial infarction.

[An efficient method for simulating ventricular electrical activity based on anatomic structure by incorporating AP model].

Conventional medical experiments can hardly simulate cardiac excitation propagation and observe the evolvement of cardiac electrical activities firsthand as is possible with computer simulation. Based on the anatomic structure of the heart, simulation of cardiac electrical activity mainly consists of the emulation of the excitation process among the cardiac cells and calculation of the electrical activities of individual cardiac cells. In this study we establish a geometric ventricular structure model demonstrating the direction of the cardiac muscle fibers and the layers of the ventricular cells, and endow different action potential models to the ventricular cells of different layers, and observe the activation process of the ventricular parts in view of the three-dimensional anatomy. This method gives attention to both enough calculation amounts and efficiency, which achieves satisfactory simulation results of ventricular electrical activity based on the anatomic structure and cell electrophysiology through an improved algorithm on personal computer.

Truth telling in medicine: the Confucian view.

Truth-telling to competent patients is widely affirmed as a cardinal moral and biomedical obligation in contemporary Western medical practice. In contrast, Chinese medical ethics remains committed to hiding the truth as well as to lying when necessary to achieve the family's view of the best interests of the patient. This essay intends to provide an account of the framing commitments that would both justify physician deception and have it function in a way authentically grounded in the familist moral concerns of Confucianism. It reflects on the moral conditions and possibilities for sustaining a Confucian understanding of truth-telling and consent in mainland China.

[Fast elimination of 50-Hz noise in PC-based application system].

The interference by 50-Hz noise arising from the power supply cables is common in PC-based application system, often considerably affecting the detection of useful signals. On the basis of self-adapting correlation method, we attempt to address the problem of fast elimination of 50-Hz noise from the useful signals in PC-based application system such as digital ECG recording system.